Summertime brings so much fun and sweat. Unfortunately for our private parts this humidity can bring unwanted itchiness and discomfort. Many kids show up in clinic this time of year with urinary symptoms such as dysuria, itch and discomfort to their parts. Yet often the urine exams are normal for these kids. Once a urinary tract infection has been ruled out by U/A (quick dip) or urine culture (send off that take 2-3 days to result) the guilty party is most likely yeast combined with local irritation. This is what we call candidal balanitis for boys or vulvovaginitis for girls. This diagnosis is especially important for kids with bright red irritated private parts. This irritation is more common in our boys with foreskins and those of us with lady parts.
Candida albicans is the most common species of yeast that causes trouble for us humans both big and small. Yeast love dark moist environments and our private parts and creases are simply the dream home for these pesky guys. The way I approach this problem is 1st to rule out a UTI (urinary tract infection). If there is no evidence of bacteria I set my scope on yeast. The way to keep yeast in check is to take away what it loves. Yeast loves moisture so we keep our privates dry and aired out! This means as soon as we are done swimming we change out of at least our wet bottoms. If your child is going to be in and out of the water all day for example at a water park a good barrier cream such as A&D ointment can protect their privates from the prolonged moisture/irritation of a wet suit. Wear skirts! Sarongs! anything that lets the breeze blow. Dress your kids in cotton. Avoid synthetic underwear even those labeled as”moisture wicking.” Avoid skinny jeans, biker shorts and leggings as they make your rear sweat and they limit air flow. If your child is still in a diaper leave one off when you can. It’s good idea to let our kids go commando at home especially after bath time until they are completely dry! If nudity is weird to your family put a long T-shirt on them but leave their bottoms to air out. Very important though if your child is scratching at themselves terribly it is better to cover the area to avoid secondary infections. I often explain its ok to scratch through your undies but not under them as our nails can tear up the delicate skin and worsen the situation. Keep their nails clean and short though just in case. This is called the Summertime Itch for a reason!!!!
Avoid soaping up privates. They are self-cleaning ovens. Simple warm water is the best bet for uncircumcised boys and all ladies. Soap disrupts the genitourinary flora giving yeast an advantage.
The next piece is harder. Yeast love sugar. Sugar is in everything. Read your labels and try to limit your child or yourself to less than 20g of sugar (preferably from starches). Limit completely empty/fast-acting sugars such as soda, juice, Gatorade, cookies, candies, ice cream, and popsicles. Drink water! Probiotics can help as well. The good bacteria help to crowd out the bad guys that make us itch. Be careful when buying yogurt as many have huge amounts of sugar per serving to make it less sour and more palatable to Americans. One easy way to avoid the issue is to buy plain yogurt/kefir and then sweeten it with a dab of honey. I dip a chopstick in honey. Swirl it over kefir (Trader Joe’s plain). Then I let the kiddo lick off what’s left. So with each drink he senses a ton of sweetness but compared to commericial yogurt it’s very low glycemic. Next time you are at the store check out the sugar content in the usual yogurts. It will blow your mind what is in this “health food.”
Finally antifungals such as clotrimazole used 2x/day topically on itchy parts can make a nice difference in just a few days. The only problem is that if we do not address our diets the yeast will come right back. Good luck out there! Cheers to happy, healthy parts.